Thursday, May 12, 2016

The (Hopefully) Lowest Point of Our Trip

Me to my girlfriend at 3 am this morning:  "I think I'm going to have diarrhea again.  Do you need to vomit, or can I use the bathroom first?"

#alwayssaynotouncookedvegetables

Sunday, May 8, 2016

Cairo

It took three flights, almost 24 hours, and a small meltdown in the Frankfurt airport, but my girlfriend and I are now comfortably settled in an apartment in the Heliopolis neighbourhood of Cairo.  The two days since we arrived have been devoted to seeing as many people as possible (my girlfriend lived in Cairo for three years and, being an extrovert unlike me, left behind a long list of people who love and miss her), adjusting to the seven hour time difference, and challenging the defences of our gastrointestinal tracts with street foods.  Shawarma...mmmm...

As we were waiting in the airport in our home city, we ran into our accountant, who was waiting to fly to his vacation home in Phoenix.  The girlfriend and I were already in vacation mode, eating hot dogs and deciding which of the many ebooks we had downloaded to read first, while the accountant was surrounded by his computer and cell phone and stacks of papers.  When he saw us, he quickly picked up his phone to call the Canada Revenue Agency about an issue with my tax return, and after speaking with someone, he called over to me to let me know that he had resolved the issue.  His voice was eager, like a child seeking praise. "Look at me!  I'm on vacation but I'm still working for you!  Aren't I great?"

And then he chatted with us about where we were going and how long we were going to be away.  When I told him that we were traveling for three weeks, and that I had left all of my work at the hospital, a momentary flash of disgust passed over his face.  He recovered quickly, but he still made it clear that he didn't approve of my prolonged absence.  "Three weeks?  No doctor goes away for three weeks!  That's crazy!"

Which it shouldn't be.  When I am at work, I work very hard, often giving up lunches to finish paperwork and coming in early so that I can fit in another urgent patient.  So why on Earth should I have to apologize to my accountant about wanting to take some time away for myself?  Why does medicine (and North American society as a whole) fetishize work so much that people are viewed as weak or as failures if they choose to do anything other than work?

I refuse to apologize for not wanting to give my entire life to medicine.  The further I get into my career, the more I realize I'm going to have to fight the dominant culture of medicine in order to take time for myself, but I'm prepared to do that.  Life outside of medicine is too sweet to squander it all simply to meet other people's expectations of me.

Sunday, May 1, 2016

The Way Things Should Be

Like a number of my favourite bloggers (see here and here), I recently read Leo Babauta's post about how to not be frustrated all the time.  In the post, he argues that frustration arises from our desire for things to be different from how they are.

"It’s from not wanting things to be a certain way. Not wanting other people to behave a certain way. Not wanting ourselves to be a certain way."

 Yup.  Welcome to my life.  After reading the post, I started paying attention to how much mental energy I expend wishing that things were different, and I was shocked by the fact that there is pretty much a never ending stream of thought going through my head that judges everything in my life as inadequate.  For example:

When waking up in the morning: "I wish it wasn't Tuesday and that I didn't have to get up and go for a run, because I'm tired and want to stay in bed under the warm covers and running sucks and I'm out of shape and I'm never going to get in shape anyway."

When walking to clinic:  "I wish I didn't have so many patients booked because I'm sure some of them are going to be really challenging and then I'm going to feel rushed, and feeling rushed makes me stressed, and I hate being stressed, and if I were a better doctor I would never feel stressed."

When dictating:  " I hate dictating, it's so boring and it takes so much time, and I don't have enough time for fun things or for more important work because I'm always spending time dictating, and if I were a better doctor I wouldn't take so long to do my dictations."

When leaving work:  "It's nice that work is over, but the evenings are never long enough, and I have to do things that aren't fun like cook supper and wash dishes and that always ruins the little bit of time I have when I'm not working."

And on and on and on.  The funny thing is, before paying attention to my thoughts, I would have described myself as a positive person.   I'm generally pretty happy, and I'm usually able to find the positive side of a situation, so I was shocked to realize just how much negative crap goes through my head on a daily basis.

Once I was conscious of my thought patterns, I realized how incredibly draining all of the negative crap is.  So I'm trying to change it.  I'm trying to follow Babauta's advice to become aware of my frustration and to let go of my expectation that things will always go my way.

"You want things to go your way, want people to behave the way you want them to. But you don’t and can’t control the universe. You aren’t entitled to getting everything your way."

Now, when I start down the horrible negative thought death spiral, I try to catch myself and be aware of it.  And then I try simply to not engage in all of the negative thinking (sometimes easier said than done).  I acknowledge that I would rather be on my couch drinking an Old Fashioned than sitting in my office doing my 12th dictation of the day, but that isn't my reality.  Or that I wish my girlfriend wouldn't look like she's on a terrifying roller coaster ride every time I drive, but that is my reality.  And I am better off accepting these things (as much as I can) than I am constantly raging against them.

The amazing thing to me is that it's actually helping.  I don't dread dictations and paperwork nearly as much as I used to, and I'm more efficient at them because I'm not wasting time feeling like the most hard done by person on the face of the Earth.  I'm not freaking out when I take longer than planned with a patient, because I know that there is some cushion in my schedule, and life will go on even if my clinic runs overtime.  Things feel surprisingly easier, despite making what seems like a very minor change in my thinking.

Since that Babauta post, I've encountered the same ideas in a few different places.  (It's almost like the universe is trying to tell me something.)  I went to a workshop about physician burnout on Friday, and there was a session on mindfulness meditation that explored the same concepts.  I recently finished a really good book called 10% Happier, which is about a tv anchorman's experiences with mindfulness meditation.  The more I encounter the idea, the more I think I might benefit from spending more time exploring the concept of mindfulness.

Which will unfortunately have to wait, because on Thursday I hop on a plane for three weeks in Egypt, Greece, and Jordan.  While this sounds wonderful (vacation!), I'm honestly a bit terrified, because there are going to be some major challenges.  Such as 24 hours of travel, jet lag, staying in an apartment that is 100 stairs from the main floor (no elevator), highs of 44 C*, crowds, noise, and two out of three weeks spent with my girlfriend's family.  Oh, and the fact that most of the places we're traveling to hate the gays, so we'll have to pretend that we're roommates.  My goal for the trip (Let's call this my May goal, shall we?) is to be mindful of all the things about travel that frustrate me and to do my best to let go of them.

Or, at the very least, to not have a screaming match with my girlfriend in front of the pyramids.

*I think the hottest I've ever experienced was about 35 C, and I felt like I was going to die.

Sunday, April 10, 2016

March/April Goals - Eat Food

Once again, I'm late with reflecting on last month's goals and setting out this month's goals.  Perhaps my goal for this month should be to be on time with my next post about goals?

Anyway...for March, I made a very vague commitment to "recognize what I need and to meet those needs".  I was feeling in a bit of a slump at the time, and I couldn't quite figure out what would make me feel better, so my goal was essentially an attempt to identify anything that would make me feel better and do it.  After a few days of self reflection, I realized that one of my biggest sources of unhappiness was feeling like I was spending all of my time doing the tedious parts of my job (dictating, editing dictations, reviewing labs) without ever being finished with it.  In response to this, I made it my priority to get all the stuff done, and I did.  (As I wrote about here).

In getting caught up on my work, and even more so in trying to prevent the work from reaccumulating, I have come to realize that I was making the fatal mistake of letting my work expand to fill the time available to me.  I'm usually in clinic only about 50% of the time, leaving me with more than enough time for office work when I'm not on call, and I was allowing the tedious work to unnecessarily fill up all of my non-clinic time.  I would come in a bit late, have a nice long coffee break, check Facebook, and do all kinds of things to procrastinate getting the work done because there wasn't a real urgency to doing it.  When I had another project to work on, such as a presentation with a firm deadline, then I would get more efficient at the tedious work to make time for the other project, but otherwise I was dawdling.  And feeling trapped in paperwork hell.

Forcing myself to finish my tedious work on a daily basis (as much as possible) has made me much more efficient.  I come in on time, I minimize non-work activities, and I use even the random five- or ten-minute chunks of available time between events to be productive.  There is absolutely no way that I want to stay later than I need to because I've been scrolling through Facebook instead of signing off on dictations.  By making much better use of my time, I've finally freed up some of the big chunks of time that I need for bigger projects.  Which feels awesome.

So, March goal?  Let's call it a success.

April Goal - Eat Food:

A lot of my time with patients is spent counseling them on living a healthy lifestyle.  Many of them hope that I hold a magical secret to living better, but in reality, my advice to them is always pretty basic:  Get exercise (30 minutes per time, 3-5 times per week).  Eat more healthy food (fruits, vegetables, lower-fat dairy, lower-fat meat/meat alternatives, whole-grain products).  Eat less unhealthy food (pop, chips, fast food, processed food, sugar).  Simple in theory, frustratingly difficult in practice.

After spending my days giving (what I think is) fundamentally sound advice, I unfortunately often go home and sit on my couch eating precisely the things I tell my patients not to.  I love pop.  And chocolate.  And ice cream.  And eating out in almost any restaurant, including the greasiest of greasy spoons.  I am an extraordinary hypocrite, and I know it's something I need to work on. 

About a week ago, my girlfriend and I watched an excellent documentary featuring Michael Pollan, an author who has written books about the problems with the industrial food system and with our current approach to eating healthily.  The documentary focuses around Pollan's simple advice on how to eat:


As I was watching the documentary, I was struck by how simple the advice was, and by how horribly I fail to live up to it.  Even though I actually like real, unprocessed, healthy foods.  The main reason I eat so much bad food is laziness and accessibility, both of which I can change.  So...I'm making two commitments for the months that fall under the heading of "Eat Food". 

1)  No pop.  It's something I don't need, and it's one of the worst things I can possibly consume.  So for this month (if not longer), I'm done with it. 

2)  Take one fruit and one vegetable in my lunch every day.  It's a small start, but it is at least a start.  I bought an assortment of vegetables at the grocery store today, I've cut up a bunch of vegetables to take in my lunches, and I'm ready to be successful at this one.

Now I'm off to Red Lobster for dinner.  I wonder if they sell any real food....

Friday, April 8, 2016

Values

Tonight I went to a talk about climate change by Naomi Klein, a Canadian writer and activist.  Going into it, I was worried that it was going to be a depressing lecture about how the Earth is doomed, complete with photos of polar bears floating adrift on melting icebergs.


Instead, the talk was a call for transformation - from fossil fuel to renewable energy, from a profit-driven economy to a human-centred society, from isolation to community.  It was 90 minutes of a left-wing, granola crunchy vision for humanity*, and I loved it.  Her talk encompassed everything I believe about how the world should strive to operate, only articulated in a vastly more intelligent and entertaining way than I ever could.

As I listened, I was hopeful that the world might just be capable of realizing the things I believe in:  environmental sustainability, racial/gender/sexual equality, empowerment of the poor and the marginalized.  And I wondered, what is my role in this?  As a physician (and as a queer, able-bodied, white, upper class woman), how do I live out my values and contribute to the society that I want to see?  How do I move beyond earning a paycheque and paying off debt to making a lasting change in my community?

I don't quite know yet, nor do I have the energy to really delve into this question late on a Friday night, but it is definitely something to think about.  Any ideas?

*Supported by a very solid research base and understanding of economics/politics/world systems. 

Tuesday, April 5, 2016

Happiness Over Money

Years ago, soon after I had started medical school, a friend of mine who is a physician came in from out of town for a visit.  During his stay, I inundated him with questions about medicine and work life balance and time off for physicians.  When the subject of vacation came up, I was quite surprised to hear that he could take almost as much time off as he wanted to, but he didn't.  It was, he said, too hard to give up the money.

At the time, I didn't understand.  I viewed vacation as a wonderful time of happiness and freedom, and I couldn't imagine passing it up for more money when doctors already make lots of money.

Fast forward eight or nine years, and I understand completely.  When the amount you earn is directly proportional to the amount you work, and especially when you still have 5-10 years of debt repayment ahead of you, it's really hard to justify time off from work.  Every day off is a calculation: 

One half day of clinic x X patients/half day x $Y/patient = I think I'll go to work.  

It's so easy to look at that calculation and think that I don't need a vacation and that it's okay for me to miss out on the things that make me happy.  Except that I do.  And it isn't.

So I'm learning to value my time more than my income.  It started today, with cancelling a half day clinic so that I can go to a really interesting conference on work life balance.  And then, emboldened by that decision, I decided to take an entire week off during our local theatre festival.  A week!  It took me hours to commit to the decision, but now that I've made it, it feels right.  It feels entirely right for me to make time for something that I love that gives me joy.

After all, why else am I here?

Wednesday, March 30, 2016

Exhaling

For weeks (months? years?) I've been feeling overwhelmed by work.  My desk has been covered with charts and lab results, my dictation inbox has been overflowing with letters to edit, and I've been weeks behind on my to do list.  No matter how much effort I put in, it seemed like I was never doing any better than keeping the piles from growing larger.  And I hated it.

About two weeks ago, I had finally had enough of all of the things that loomed over me, so I made it my goal to get caught up on everything.  Everything.  Whenever I had a spare minute, I tackled the things that needed to be done.  I went into work early and stayed late.  I worked through lunch.  I logged on from home when I had extra time in the evenings or on weekends.  I worked my butt off, and I got shit done.  And now?  I'm caught up.  There are zero charts on my desk and zero dictations to sign off on.

All done.

It feels amazing.  I no longer want to scream at my administrative assistant* when she brings a pile of lab results into my office.  I have actual time to do the big picture things, like read journal articles and prepare presentations and (maybe someday) finish the article on my fellowship research.  By getting caught up, it is now possible to keep up with the things that come in every day and to stay caught up. 

Best.  Feeling.  Ever.

The only problem?  I'm so used to existing in a state of chaos and panic that I don't know how to function with the stress gone.  With nothing screaming at me to pay attention to it, it's hard to pay attention to anything.  How is a procrastinator to function once they stop procrastinating?

*I have never done this, because I'm not a jerkface.  Any physician who yells at people in his or her workplace (or anyone else, for that matter) is a jerkface.